Retrospective chart review of impact on intubation rate and safety of high-flow nasal cannula therapy on a general pediatric ward

We examined the clinical and physiological benefits of heated humidified high-flow nasal cannula (HHHFNC) in treating pediatric bronchiolitis in a general pediatric ward. Children aged 0 to 2 years, hospitalized with moderate to severe bronchiolitis, were connected to HHHFNC. Each child was evaluated at 4- to 10-hour intervals, both on and off the device, using the Wang et al Bronchiolitis Severity score and transcutaneous CO2 monitor. Sixteen children were included in the final analysis. The Bronchiolitis Severity score improved by 3 points during the first and second intervals ( P = .001). Transcutaneous CO2 values were reduced by an average 8.7 mm Hg ( P = .001). No adverse effects were noted in children connected to the device. The HHHFNC device used in a general pediatric ward setting served as a safe and efficacious tool in treating moderate to severe bronchiolitis. Immediate clinical and physiological improvement was observed and maintained 1 to 4 hours after disconnection from the device.

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The Impact of High-Flow Nasal Cannula on the Outcome of Immunocompromised Patients with Acute Respiratory Failure: A Systematic Review and Meta-Analysis

Medicina ◽

10.3390/medicina55100693 ◽

2019 ◽

Vol 55 (10) ◽

pp. 693 ◽

Cited By ~ 4

Author(s):

Cheng ◽

Chang ◽

Wang ◽

Hsiao ◽

Lai ◽

...

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Meta Analysis ◽

High Flow ◽

Nasal Cannula ◽

Immunocompromised Patients ◽

Intubation Rate ◽

High Flow Nasal Cannula ◽

Control Groups ◽

And Control

Background and objectives: High-flow nasal cannula (HFNC) can be used as a respiratory support strategy for patients with acute respiratory failure (ARF). However, no clear evidence exists to support or oppose HFNC use in immunocompromised patients. Thus, this meta-analysis aims to assess the effects of HFNC, compared to conventional oxygen therapy (COT) and noninvasive ventilation (NIV), on the outcomes in immunocompromised patients with ARF. The Pubmed, Embase and Cochrane databases were searched up to November 2018. Materials and Methods: Only clinical studies comparing the effect of HFNC with COT or NIV for immunocompromised patients with ARF were included. The outcome included the rate of intubation, mortality and length of stay (LOS). Results: A total of eight studies involving 1433 immunocompromised patients with ARF were enrolled. The pooled analysis showed that HFNC was significantly associated with a reduced intubation rate (risk ratio (RR), 0.83; 95% confidence interval (CI), 0.74–0.94, I2 = 0%). Among subgroup analysis, HFNC was associated with a lower intubation rate than COT (RR, 0.86; 95% CI, 0.75–0.95, I2 = 0%) and NIV (RR, 0.59; 95% CI, 0.40–0.86, I2 = 0%), respectively. However, there was no significant difference between HFNC and control groups in terms of 28-day mortality (RR, 0.78; 95% CI, 0.58–1.04, I2 = 48%), and intensive care unit (ICU) mortality (RR, 0.87; 95% CI, 0.73–1.05, I2 = 57%). The ICU and hospital LOS were similar between HFNC and control groups (ICU LOS: mean difference, 0.49 days; 95% CI, −0.25–1.23, I2 = 69%; hospital LOS: mean difference, −0.12 days; 95% CI, −1.86–1.61, I2 = 64%). Conclusions: Use of HFNC may decrease the intubation rate in immunocompromised patients with ARF compared with the control group, including COT and NIV. However, HFNC could not provide additional survival benefit or shorten the LOS. Further large, randomized controlled trials are needed to confirm these findings.

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Efficacy of High-flow Nasal Cannula Oxygen Therapy in Patients with Mild Hypercapnia

10.21203/rs.3.rs-616727/v1 ◽

2021 ◽

Author(s):

Lingling Su ◽

Qinyu Zhao ◽

Taotao Liu ◽

Yujun Xu ◽

Weichun Li ◽

...

Keyword(s):

Oxygen Therapy ◽

Medical Information ◽

Characteristic Curve ◽

Predictive Performance ◽

High Flow ◽

Nasal Cannula ◽

Intubation Rate ◽

High Flow Nasal Cannula ◽

Inpatient Hospitalization ◽

Significant Difference

Abstract Objectives: To investigate the indications of high-flow nasal cannula (HFNC) oxygen therapy among patients with mild hypercapnia and to explore the predictors of intubation when HFNC fails.Methods: This retrospective study was conducted based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Adult patients with mild hypercapnia (45<PaCO2≤60 mmHg) received either HFNC or noninvasive ventilation (NIV) oxygen therapy. Propensity score matching (PSM) was implemented to increase between-group comparability. The Kaplan-Meier method was used to estimate overall survival and cumulative intubation rates, while 28-day mortality, 48-hour and 28-day intubation rates were compared using the Chi-square test. The predictive performances of HR/SpO2 and the ROX index (the ratio of SpO2/FiO2 to respiratory rate) at 4 hours were assessed regarding HFNC failure, which was determined if intubation was given within 48 hours after the initiation of oxygen therapy. The area under the receiver operating characteristic curve (AUC) for HR/SpO2 and the ROX index were calculated and compared.Results: A total of 524,520 inpatient hospitalization records were screened, 106 patients in HFNC group and 106 patients in NIV group were successfully matched. No significant difference in 48-hour intubation rate between the HFNC group and the NIV group (14.2% vs. 8.5%, P=0.278); patients receiving HFNC had higher 28-day intubation rate (26.4% vs. 14.2%, P=0.029), higher 28-day mortality (17.9% vs. 8.5%, P=0.043), longer ICU length of stay (4.4 vs. 3.3 days, P=0.019), compared to those of NIV group. The AUC of HR/SpO2 at 4 hours after the initiation of HFNC yielded around 0.660 for predicting 48-hour intubation, greater than that of the ROX index with an AUC of 0.589 (P<0.01).Conclusions: HFNC therapy cannot completely replace NIV for patients with mild hypercapnia. As opposed to the ROX index, a modest, yet improved predictive performance is demonstrated using HR/SpO2 in predicting the failure of HFNC among these patients.

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Safety Assessment of a Noninvasive Respiratory Protocol for Adults with COVID-19

Journal of Hospital Medicine ◽

10.12788/jhm.3548 ◽

2020 ◽

Vol 15 (12) ◽

pp. 734-738

Author(s):

William E Soares III ◽

Elizabeth M Schoenfeld ◽

Paul Visintainer ◽

Tala Elia ◽

Venkatrao Medarametla ◽

...

Keyword(s):

Patient Safety ◽

Respiratory Distress ◽

Healthcare System ◽

Safety Assessment ◽

Chart Review ◽

Retrospective Chart Review ◽

High Flow ◽

Adult Patients ◽

Do Not Resuscitate ◽

High Flow Nasal Cannula

As evidence emerged supporting noninvasive strategies for coronavirus disease 2019 (COVID-19)–related respiratory distress, we implemented a noninvasive COVID-19 respiratory protocol (NCRP) that encouraged high-flow nasal cannula (HFNC) and self-proning across our healthcare system. To assess safety, we conducted a retrospective chart review evaluating mortality and other patient safety outcomes after implementation of the NCRP protocol (April 3, 2020, to April 15, 2020) for adult patients hospitalized with COVID-19, compared with preimplementation outcomes (March 15, 2020, to April 2, 2020). During the study, there were 469 COVID-19 admissions. Fewer patients underwent intubation after implementation (10.7% [23 of 215]), compared with before implementation (25.2% [64 of 254]) (P < .01). Overall, 26.2% of patients died (24% before implementation vs 28.8% after implementation; P = .14). In patients without a do not resuscitate/do not intubate order prior to admission, mortality was 21.8% before implementation vs 21.9% after implementation. Overall, we found no significant increase in mortality following implementation of a noninvasive respiratory protocol that decreased intubations in patients with COVID-19.

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Description and Validation of a Novel Score (Flow Index) as a Clinical Indicator of the Level of Respiratory Support to Children on High Flow Nasal Cannula

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1731021 ◽

2021 ◽

Author(s):

Sandeep Tripathi ◽

Jeremy S. Mcgarvey ◽

Nadia Shaikh ◽

Logan J. Meixsell

Keyword(s):

Flow Rate ◽

Odds Ratio ◽

Retrospective Chart Review ◽

Maximum Flow ◽

Weight Fraction ◽

High Flow ◽

Nasal Cannula ◽

Respiratory Support ◽

Flow Index ◽

High Flow Nasal Cannula

AbstractThis study's objective was to describe and validate flow index (flow rate × FiO2/weight) as a method to report the degree of respiratory support by high flow nasal cannula (HFNC) in children. We conducted a retrospective chart review of children managed with HFNC from January 1, 2015 to December 31, 2019. Variables included in the flow index (weight, fraction of inspired oxygen [FiO2], flow rate) and outcomes (hospital and intensive care unit [ICU] length of stay [LOS], escalation to the ICU) were extracted from medical records. Max flow index was defined by the earliest timestamp when patients FiO2 × flow rate was maximum. Step-wise regression was used to determine the relationship between outcome (LOS and escalation to ICU) and flow index. Fifteen hundred thirty-seven patients met the study criteria. The median first and maximum flow indexes of the population were 24.1 and 38.1. Both first and maximum flow indexes showed a significant correlation with the LOS (r = 0.25 and 0.31, p < 0.001). Correlation for the index was stronger than that of the variables used to calculate them and remained significant after controlling for age, race, sex, and diagnoses. Mild, moderate, and severe categories of first and max flow index were derived using quartiles, and they showed significant age and diagnosis independent association with LOS. Patients with first flow index >20 and maximum flow index >59.5 had increased odds ratio of escalation to ICU (odds ratio: 2.39 and 8.08). The first flow index had a negative association with rapid response activation. Flow index is a valid measure for assessing the degree of respiratory support for children on HFNC.

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The Effect of High-Flow Nasal Cannula Oxygen Therapy on Mortality and Intubation Rate in Acute Respiratory Failure

Critical Care Medicine ◽

10.1097/ccm.0000000000002091 ◽

2017 ◽

Vol 45 (4) ◽

pp. e449-e456 ◽

Cited By ~ 37

Author(s):

Thalia Monro-Somerville ◽

Malcolm Sim ◽

James Ruddy ◽

Mark Vilas ◽

Michael A. Gillies

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Oxygen Therapy ◽

High Flow ◽

Nasal Cannula ◽

Intubation Rate ◽

High Flow Nasal Cannula

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High-flow nasal cannula oxygen for bronchiolitis in a pediatric ward: a pilot study

European Journal of Pediatrics ◽

10.1007/s00431-013-2094-4 ◽

2013 ◽

Vol 172 (12) ◽

pp. 1649-1656 ◽

Cited By ~ 73

Author(s):

Silvia Bressan ◽

Marco Balzani ◽

Baruch Krauss ◽

Andrea Pettenazzo ◽

Stefania Zanconato ◽

...

Keyword(s):

Pilot Study ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Pediatric Ward

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Description and validation of a novel score (Flow Index) as a clinical indicator of the level of respiratory support to children on high flow nasal cannula.

10.22541/au.160684068.88421891/v1 ◽

2020 ◽

Author(s):

sandeep tripathi ◽

Jeremy Mcgarvey ◽

Nadia Shaikh ◽

Logan Meixsell

Keyword(s):

Length Of Stay ◽

Flow Rate ◽

Retrospective Chart Review ◽

Maximum Flow ◽

High Flow ◽

Nasal Cannula ◽

Respiratory Support ◽

Flow Index ◽

High Flow Nasal Cannula ◽

Independent Association

Objective: Describe & validate flow index (FiO2×flow rate/weight) to report the degree of respiratory support to children on high flow nasal cannula (HFNC) Methods: Retrospective chart review. Children managed with HFNC from 01/01/15 to 12/31/19. Variables included in the flow index (weight, FiO2, flow rate) and outcomes (hospital and ICU length of stay [LOS], escalation to the ICU) extracted from medical records. Max flow index defined by the earliest timestamp when patients FiO2×Flow rate was maximum. Step-wise regression used to determine the relationship between outcome (length of stay and escalation to ICU) and flow index Results: 1537 patients met the study criteria. Median 1st and maximum flow index of the population 24.1 and 38.1, respectively. Both 1st and maximum flow indexes showed a significant correlation with the LOS (r 0.25 and 0.31). Correlation for the index was stronger than that of the variables used to calculate them and remained significant after controlling for age, race, sex, and diagnoses. Mild, moderate, and severe categories of 1st and max flow index derived using quartiles and showed significant age and diagnosis independent association with LOS. Patients with 1st flow index >20 and maximum flow index >59.5 had increased odds ratio of escalation to ICU (OR 2.39 and 8.08). The 1st flow index had a negative association with rapid response activation. Conclusions: Flow index is a valid measure for assessing the degree of respiratory support for children on HFNC. High flow index associated with longer hospital LOS and the risk of escalation to ICU.

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